, Volume 18, Issue 8, pp 851-852
Date: 17 Jun 2003

Kawasaki disease misdiagnosed as acute pyelonephritis

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Sirs,

Kawasaki disease (KD) is a systemic vasculitis, which often presents with abnormal urinary findings, such as sterile pyuria, mild proteinuria, and microscopic hematuria [1]. We describe a pediatric patient who presented clinically as culture-negative pyelonephritis and subsequently developed classical features of KD.

A 4-year-old girl was admitted to hospital with a high fever (39.5°C), vomiting, and abdominal pains. On admission she had no mucocutaneous changes or lymph node involvement. She had moderate abdominal tenderness. The initial laboratory findings showed an increased erythrocyte sedimentation rate (ESR) of 45 mm/h and C-reactive protein (CRP) of 131 mg/l. She had leukocytosis (19.54×109/l) with neutrophilia (85%). Her urine was cloudy with many white blood cells in the urinary sediment. A presumptive diagnosis of acute pyelonephritis was established and intravenous ceftriaxone was administered. Her fever was resistant to antibiotic therapy and urine cultures revealed no